Less Is More

Simpler & Better Medicine

Oral vitamin K lowers the international normalized ratio more rapidly than subcutaneous vitamin K in the treatment of warfarin-associated coagulopathy. A randomized, controlled trial. — April 1, 2016

Oral vitamin K lowers the international normalized ratio more rapidly than subcutaneous vitamin K in the treatment of warfarin-associated coagulopathy. A randomized, controlled trial.

Summary: For patients on anticoagulation with warfarin who have an elevated international normalized ratio (INR) between 4.5 and 10, withholding warfarin and giving 1 mg oral vitamin K is more likely to result in a therapeutic INR at 24 hours than withholding warfarin and giving 1 mg subcutaneous vitamin K.

www.ncbi.nlm.nih.gov/m/pubmed/12186515/

Strength of Recommendation = B

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Health care-associated infection after red blood cell transfusion: a systematic review and meta-analysis. — January 6, 2016

Health care-associated infection after red blood cell transfusion: a systematic review and meta-analysis.

Summary: A more restrictive use of red blood cell (RBC) transfusions (eg, using a hemoglobin threshold of <7.0 g/dL) may be associated with a lower risk of serious infections than a more liberal approach to transfusions, especially for orthopedic patients and for patients presenting with sepsis.

http://www.ncbi.nlm.nih.gov/m/pubmed/24691607/

Strength of Recommendation = A

Restrictive versus liberal transfusion strategy for red blood cell transfusion: systematic review of randomised trials with meta-analysis and trial sequential analysis. — December 18, 2015

Restrictive versus liberal transfusion strategy for red blood cell transfusion: systematic review of randomised trials with meta-analysis and trial sequential analysis.

Summary: Compared to more liberal transfusion strategies, using a more restrictive transfusion threshold may lead to fewer units of red blood cells transfused and fewer patients receiving transfusions, without any positive or negative effect on risk of death, on overall morbidity, or on risk of fatal or non-fatal myocardial infarction.

http://www.ncbi.nlm.nih.gov/m/pubmed/25805204/

Strength of Recommendation = B

Transfusion strategies for acute upper gastrointestinal bleeding. — November 30, 2015

Transfusion strategies for acute upper gastrointestinal bleeding.

Summary: For patients with severe acute upper gastrointestinal bleeding, a more restrictive transfusion threshold (Hb < 7) may lead to a lower risk of death by 6 weeks (as well as a lower risk of re-bleeding and a lower risk of adverse events) than a more liberal transfusion threshold (Hb < 9).

http://www.ncbi.nlm.nih.gov/m/pubmed/23281973/

Strength of Recommendation = B

Transfusion thresholds for guiding allogeneic red blood cell transfusion. — October 16, 2015

Transfusion thresholds for guiding allogeneic red blood cell transfusion.

Summary: Using a more restrictive transfusion threshold (eg, a hemoglobin level of 7 to 8 g/dL) may be associated with a lower risk of in-hospital mortality, without any reduction in functional recovery, ICU length of stay, or hospital length of stay.

http://www.ncbi.nlm.nih.gov/m/pubmed/22513904/

(See JAMA commentary at: http://www.ncbi.nlm.nih.gov/m/pubmed/23280228/)

Strength of Recommendation = A

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